UNLABELLED: BACKGROUNDL: Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. DESIGN: A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. METHOD: Ethical approval was received. Study sites (n=12) were allocated to study arm using cluster randomisation. The experimental group (n=99) were repositioned three hourly at night, using the 30° tilt; the control group (n=114) received routine prevention (six-hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks. RESULTS:All participants (n=213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p=0·035; 95% CI 0·031-0·038; ICC=0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β=-0·246, 95% CI=-0·319 to -0·066; p=0·003); (β=0·227, 95% CI=0·041-0·246; p = 0·006). CONCLUSION:Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. RELEVANCE TO CLINICAL PRACTICE: An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.
RCT Entities:
UNLABELLED: BACKGROUNDL: Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. DESIGN: A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. METHOD: Ethical approval was received. Study sites (n=12) were allocated to study arm using cluster randomisation. The experimental group (n=99) were repositioned three hourly at night, using the 30° tilt; the control group (n=114) received routine prevention (six-hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks. RESULTS: All participants (n=213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p=0·035; 95% CI 0·031-0·038; ICC=0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β=-0·246, 95% CI=-0·319 to -0·066; p=0·003); (β=0·227, 95% CI=0·041-0·246; p = 0·006). CONCLUSION: Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. RELEVANCE TO CLINICAL PRACTICE: An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.
Authors: Francisco Manzano; Manuel Colmenero; Ana María Pérez-Pérez; Delphine Roldán; María del Mar Jiménez-Quintana; María Reyes Mañas; María Angustias Sánchez-Moya; Carmen Guerrero; María Ángeles Moral-Marfil; Emilio Sánchez-Cantalejo; Enrique Fernández-Mondéjar Journal: Intensive Care Med Date: 2014-09-05 Impact factor: 17.440
Authors: Yu-Kuang Wu; Hsin-Yi Liu; Annmarie Kelleher; Jonathan Pearlman; Dan Ding; Rory A Cooper Journal: J Spinal Cord Med Date: 2016-07-01 Impact factor: 1.985
Authors: Nancy Bergstrom; Susan D Horn; Mary Rapp; Anita Stern; Ryan Barrett; Michael Watkiss; Murray Krahn Journal: Ont Health Technol Assess Ser Date: 2014-10-01